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State of California—Environmental Protection Agency <br />'+ Foi'+fn Appro ed OMB No.2050--0039(Expires 9-30-94) See Instructions on back of `e 6. q/ Department of Toxic Substances Coo, <br /> m cr type. Form designed for use on elite(i?-pitch)t), ter. ���' (/ Sacramento,California <br /> r 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST 0 J of J <br /> 3. Generator's Nam and Mailing Address A. Stop Manifest Document Number <br /> o 045T H �GNs i�'u c T 1 o nl, -, <br /> R0, 3 o 7s8--- 37o;X0MT 5T �i0V15TA CAJAP 9�(,S7 9 . 3�$ <br /> h B. State Generator's ID <br /> CV N4. Generator's Phone <br /> 707 3 <br /> t ; <br /> ' <br /> op .. .. <br /> 05. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's IDt <br /> 41 64-577 <br /> j , C D / D. Transporter's Ph4 IL on <br /> 1 J L M/ <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> U <br /> F. Transportei s'Phone <br /> 9. Desi noted Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> ti gickS�Ai,��c, p 6 <br /> Pari' blvd. 4*• ty' <br /> � 255 PH F tli s Phone <br /> -Q R.`L��Fu►��rtc3rC'.A. r94f3t)1 [ C y 51t� ' ,'� -' �J <br /> CnU <br /> 11. US DOT Description(including Proper Shipping Name, Hazard Class,and ID Number 12. Containers 13. Total 14. Unit <br /> a Z P ( g P PP 9 ) No. Type Quantity Wt/Vol I. Waste Nuryi4 <br /> aI'A_d I Stie 1 Icier dr_'c kill, Jct-;tr ,SQJ l t State <br /> 3 E �d :t �I iC tC,1 tCIF? 'l' O O •1 Y I EPA�016er. <br /> 00 N b r' ASIA CON ,TPI(!`TITIN rf) '.NC. state <br /> E <br /> N R EPA/tither <br /> v A <br /> OT c. State <br /> °° o OCT 4 1994 <br /> = R EPA/Other <br /> w <br /> d <br /> Z State <br /> v BY ,. <br /> LU EPA/CMfteFs' <br /> N <br /> Z J ° x Descri tons for Materials Listed AboveK, Handling Codes for Wasyes Listed Above <br /> fsY <br /> ' V 4YreN}d3 <br /> Tank��1 fiY���__�, r a. O In.cy- <br /> � <br /> Lt � ' z 1 c�c�t) G liaLl t a( �:i t C. d. <br /> a <br /> Z15. Speci <br /> J al Handling Instructions and Additional Information <br /> Keep away, frc�n sources of igni lwVtys hardtlats w;> k'ng arourKI <br /> VA- Y7'z <br /> z U.G,S.T. 's 24 Hr. C:ontact �Name pt <br /> L <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed marked,and labeled,and are in all respects in proper condition for transport b highway according to applicable international and national government regulations. <br /> Q P Pe P P P Y g Y 9 PP 9 9 <br /> .J <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the vpiame and toxicity of waste generated to the degree I have determined to be <br /> -+ economically practicable and that I have selected the prcicticable method of treatment,�Storp(ge, or dls I currently available to me which minimizes the present and future <br /> a threat to human health and the environment; OR, if I am a small quantity generatq( I h e made' g d faith effort to minimize my waste generation and select the best <br /> V) <br /> waste marfqgemer4 method thl is av 'table to 14 and that I can afford. <br /> D yjz —Fri <br /> Pr i a Signature Da� o �Yeal <br /> Z11(teIt,7 <br /> , <br /> ZT 17. Transporter 1'Acknowledgement of Receipt of Materials <br /> Z R <br /> �w • Printed//Typed NamSignature L Month Day Year <br /> .! N <br /> Y S 2 <br /> L P <br /> 0 18. Transporter 2 Acknowled ement of Receipt of Materials <br /> .0 RPrinted/Typed Name <br /> rSignatureMonth Day Year <br /> LL. E <br /> O R <br /> l,t 19. Discrepancy Indication Space <br /> n <br /> Q F <br /> U A <br /> Z C <br /> 1 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Y <br /> 2- <br /> Pr' Type Name Si nature Month a Year <br /> c <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yeilow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 RAYS. <br /> DTSC 8022A (9/93) (Generators who submit hazardous waste for transport o tof-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />